Transforming fatigue services for people with inflammatory arthritis28 June 2022
Researchers have found that physical activity and talking therapies can improve fatigue in people with inflammatory arthritis and related conditions.
What is fatigue?
Fatigue is an extreme, sometimes overwhelming physical and mental tiredness.
It can affect your motivation and your ability to concentrate, making daily tasks like going to work or getting out of bed feel exhausting.
It’s a common problem associated with many forms of arthritis, especially inflammatory conditions such as rheumatoid arthritis, ankylosing spondylitis, and related conditions such as lupus - known collectively as inflammatory rheumatic diseases (IRDs).
Around 800,000 people in the UK live with IRDs and up to eight in ten of those experience fatigue, with nearly three quarters saying it’s as important as pain, the other major symptom of these conditions.
Many people with inflammatory arthritis find that fatigue makes their pain and joint stiffness worse, and some find it causes them to feel irritable or depressed.
What is the LIFT study and why is it important?
Despite its impact, fatigue is difficult to treat in people with IRDs because it doesn’t respond to medicines and can often go unrecognised by clinicians.
Our LIFT study has found for the first time that non-drug treatments such as physical activity and talking therapies delivered by non-specialists can significantly improve fatigue across this entire group of inflammatory conditions.
Previous studies have only looked at these treatments for fatigue in specific conditions.
The researchers at the universities of Aberdeen and Glasgow who led the study say the findings mean these treatments should become a core part of treating IRDs in clinical practice.
What did the researchers do?
The researchers compared three different types of care, as provided to 368 people with various inflammatory rheumatic diseases.
Study participants were assigned to one of three groups:
- The physical activity group were given an average of five one-to-one telephone-delivered sessions over 30 weeks, designed to help build preferred types of physical activity into their lives at their own pace.
- The cognitive behavioural group were given an average of eight sessions over 30 weeks, which included talking therapies, goal setting, a daily activity diary, and more.
- The ‘usual care’ group received a Versus Arthritis education booklet on fatigue.
The physical activity and cognitive behavioural approaches were both delivered by local NHS rheumatology healthcare professionals.
What have they found?
The researchers found that telephone-delivered physical activity programmes and cognitive behavioural approaches significantly improved fatigue compared to people receiving usual care.
The people who received the treatments had significant reductions in the severity and impact of their fatigue and these benefits were maintained six months following completion of their treatment.
They also saw improvements in their mental health and sleep.
Lead investigator, Professor Neil Basu who carried out the majority of the research at the University of Aberdeen, but now of the University of Glasgow, said: “Our study is unique in that it looks at the whole breadth of inflammatory rheumatic diseases and as such is more aligned with the demands that would be put on a rheumatology service.
"Moreover, it provides new evidence that some non-pharmacological interventions can be successfully and effectively delivered by non-specialist members of the clinical service.”
Commenting on LIFT, Dr Neha Issar-Brown, Director of Research and Health Intelligence at Versus Arthritis, said:
“There is an urgent and unmet need for more evidence-based interventions including better access to non-drug treatments like Cognitive Behavioural Therapies (CBT) and supported physical activity, so more people with IRDs can retain their independence, stay in work, and enjoy better mental health, which we know these conditions can cruelly take away.
“The LIFT study’s implementation across the health service would give people with inflammatory arthritis and related conditions access to the support they need to manage fatigue while producing long lasting improvements to their mental health.”
What’s next for the LIFT study?
With the publication of the LIFT findings, NHS Trusts now have access to an evidence-based programme of support for fatigue in all inflammatory rheumatic diseases.
The LIFT programme manuals are now openly available online and the researchers say they should become a core part of treating these conditions in clinical practice.
“The fatigue really affects what you can do,” says Wendy Booth, 57, who lives with lupus and Sjögren’s syndrome. “If I do some work in the garden one day, I know I’ll pay for it the next. You really need to learn how to pace yourself but whilst I’ve tried, I’ve never really managed to hold back!”
Wendy received physical activity sessions as part of the LIFT study and has now joined a gym, saying she feels mentally and physical stronger than before: “The physio called me about once a fortnight and it really encouraged me. I feel like it helped give me purpose.
"I really started to enjoy the strength-building exercises they gave me and I’ve kept it up ever since.”
“The LIFT programme has given me the tools to live my best life and stop me feeling guilty about not being the mum or grandma I used to be,” says Carol Scholes, 66, who lives with rheumatoid arthritis and other mixed connective tissue disease.
She received the cognitive behavioural intervention as part of the LIFT study and said: “Fatigue can affect your whole sense of worth, self-esteem, and confidence.
"I feel very vulnerable and always worry about where I’ll be able to park the car or whether I’ll need to stand for ages in a queue.
“I really felt like I was working together with the rheumatology team, rather than being told what to do. I was encouraged to apply what I was learning to my life.
"I remember one week I had a wedding coming up which I was anxious about, and if hadn’t used some of the tools I’d learned, like planning where I could go to have half an hour’s quiet and rest, I wouldn’t have got through it.”
The LIFT study was led by the universities of Aberdeen and Glasgow and carried out by the NHS and other academic partners, including the University of Manchester, Kings College London, Glasgow Caledonian University and the University of the West of England.
The LIFT findings are available to read in full.
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